Chronic Kidney Disease-Mineral and Bone Disorder KDIGO Guidelines

• one measure of the skeletal component of the systemic disorder of CKD-MBD that is quantifiable by histomorphometry of bone biopsy. The guidelines themselves focussed on three key domains relating to: (1) diagnosis of CKD-MBD with respect to biochemical abnormalities, bone and vascular calcification, 2009 saw the publication of the clinical practice guidelines from Kidney Disease Improving Global Outcomes (KDIGO) relating to diagnosis, evaluation, prevention and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD) [1] . KDIGO has utilised a grading system for clinical practice recommendations with the strength of recommendation being graded as level 1 or level 2, with level 1 being a ‘we recommend ...’ statement implying most patients should receive this action whilst level 2 is a ‘suggestion’ recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’ evidence base. KDIGO defined CKD-MBD as systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: • abnormalities of calcium, phosphate, parathyroid hormone (PTH) or vitamin D metabolism, • abnormalities in bone turnover, mineralisation, volume, linear growth or strength, • vascular or other soft-tissue calcification. To avoid confusion renal osteodystrophy was defined as: • an alteration of bone morphology in patients with CKD, Published online: May 12, 2010